2017-08-14T15:31:13-05:00 2016-09-30 010494526 Baker Newman & Noyes PO Box 507 Portland ME 04112 990 2015-10-01 222594672 Concord Hospital Inc CONC 6032284677 250 Pleasant Street Concord NH 03301 Scott W Sloane Senior VP, CFO, & Treasurer 6032284677 2017-08-10 Nicholas E Porto P01310283 2078792100 2017-08-10 2015 2021-01-29 14:40:06Z Robert P Steigmeyer 250 Pleasant Street Concord NH 03301 559569503 0 X www.concordhospital.org X 1944 NH Hospital 16 14 3886 400 2311426 -676172 4253898 4971807 427186497 454166541 12809880 27684561 324507 374717 444574782 487197626 204539 293077 0 0 243678433 262280773 0 0 0 173330906 186380833 417213878 448954683 27360904 38242943 490430685 519420194 258381331 271871191 232049354 247549003 Concord Hospital is a charitable organization which exists to meet the health needs of individuals within the communities it serves. 0 0 374453193 293077 452237725 Various hospital services; see Schedule HIn FYE 2016, Concord Hospital invested more than $72 million for community benefit programs, services, and other expenses. The largest areas of support were charitable care services, medical education and subsidized programs and services. Our investment enhances the Hospital's ability to provide quality patient care, respond to identified community health needs and address the Hospital's charitable mission overall. 374453193 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 270 0 1 3886 1 1 1 0 0 0 0 0 0 0 0 0 X 16 14 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 NH X X Scott Sloane VP Finance 6032277000 250 Pleasant Street Concord NH 033017539 Valerie Acres Esq Trustee 1.00 1.00 X 0 0 0 D Thomas Akey MD Trustee (thru 1/16) 40.00 4.10 X 299181 0 68396 Diane E Wood Allen RN Trustee (thru 7/16) 40.00 0.00 X 258007 0 62347 Sol Asmar Trustee 1.00 1.00 X 0 0 0 Frederick Briccetti MD Trustee 1.00 0.00 X 0 0 0 William L Chapman Esq Trustee 1.00 1.00 X 0 0 0 Michelle Chicoine Trustee 1.00 0.00 X 0 0 0 Douglas Ewing MD Med Staff President (thru 1/16) 1.00 0.00 X 0 0 0 Christian Hallowell MD Trustee (thru 1/16) 1.00 1.00 X 0 0 0 Peter Noordsij MD Trustee 1.00 0.00 X 0 0 0 Muriel D Schadee CPA Trustee 1.00 4.10 X 0 0 0 Robert Segal Trustee 1.00 0.00 X 0 0 0 David A Stevenson MD Trustee 40.00 1.00 X 256440 0 42000 Jeffrey K Towle Trustee 1.00 1.00 X 0 0 0 Robert Thomson MD Medical Staff President 1.00 0.00 X 0 0 0 Claudia Walker Trustee 1.00 1.00 X 0 0 0 Philip Boulter MD Chair 1.00 5.10 X X 0 0 0 David Ruedig Vice Chair 1.00 4.10 X X 0 0 0 Mary Boucher Secretary 1.00 1.00 X X 0 0 0 Robert P Steigmeyer President & CEO 55.00 5.10 X X 805372 0 151032 Bruce R Burns Treasurer 55.00 5.10 X 476061 0 61982 David Green MD Chief Medical Officer 50.00 0.00 X 495092 0 65394 Gerald Sardella MD Physician 50.00 0.00 X 577765 0 42071 Joe Conley COO 50.00 0.00 X 422616 0 66466 George Pope MD Physician 50.00 0.00 X 470310 0 41910 Todd Burdette MD Physician 50.00 0.00 X 450375 0 58021 4511219 0 659619 386 0 1 0 Concord Emergency Medical Assoc 540 Lafayette Road Hampton NH 03842 Physician services 9669836 Elliot Hospital 1070 Holt Avenue Suite 2100 Manchester NH 03109 Healthcare services 1721407 Angelica PO Box 535122 Atlanta GA 303535122 Laundry Services 1317208 ARUP Laboratories PO Box 27964 Salt Lake City UT 84127 Laboratory Services 1114546 ROI Companies 85 Prescott Street Suite 402 Worcester MA 01605 Collection Services 1029867 30 4971807 4971807 Net Patient Service 621400 434691369 434691369 Disproportionate Share Funding 621400 7799997 7799997 Other Operating Revenue 621400 6391792 5300847 1090945 Food Services 722210 3963260 2750672 1212588 Child Care Center 624410 962182 962182 357941 357941 454166541 1165391 7893 1157498 374717 0 374717 374717 374717 98821793 69254 72101166 270711 26720627 -201457 26519170 26519170 487197626 452237725 2311426 27676668 293077 293077 2480816 901330 1579486 205186680 171198623 33988057 12160265 10199979 1960286 28622743 23721030 4901713 13830269 11442535 2387734 1092148 137510 954638 217719 217719 132950 132950 84482 84482 797652 797652 20711100 16687437 4023663 220585 76024 144561 10303373 7829907 2473466 8912792 4168964 4743828 12435653 10197084 2238569 900140 441034 459106 694752 493196 201556 3590786 2513550 1077236 22953067 16067147 6885920 5986617 5986617 Medical/Surgical Suppli 50755693 50755693 Medicaid Enhancement Ta 19679075 19679075 Bad Debt Expense 17588543 17588543 Repairs/Maintenance 3441354 813555 2627799 5882352 3261283 2621069 448954683 374453193 74501490 0 10919185 9486725 7394804 19512276 51848555 52115572 1341543 1261983 5195325 4900762 400578728 257675981 134062971 142902747 150784684 142874766 96120460 117268117 2205079 4854804 972802 0 29585277 24242442 490430685 519420194 59015443 56184600 103354858 93969212 96011030 121717379 258381331 271871191 X 232049354 247549003 232049354 247549003 490430685 519420194 X 38242943 -4687662 -18055632 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 36482 0 0 1 48000 84482 0 Part II-B, Line 1: Concord Hospital was a member of the American Hospital Association & New Hampshire Hospital Association in the fiscal year ended 9/30/16. A portion of the dues paid to these organizations were available for lobbying expenditures on behalf of Concord Hospital and the other member organizations in furtherance of their exempt purposes. The portions of dues used for lobbying by the American Hospital Association and New Hampshire Hospital Association were $8,678 and $27,804, respectively. Concord Hospital has hired an outside consultant to perform services to further Concord Hospital's mission. This consultant was paid $48,000 in the year ended 9/30/16. 232130222 1940394 6298683 477119 239892180 243015224 1036824 -9845448 2076378 232130222 210537884 19493511 13878348 894519 243015224 159691844 28914868 22620824 689652 210537884 139047220 3169850 18200869 726095 159691844 1.00000 0.00000 0.00000 0 1 1 18996 18996 147497100 74319909 73177191 3983974 244901 3739073 233384668 183111171 50273497 15693990 15693990 142902747 Alternative Investments 117268117 F 117268117 Estimated 3rd Party Settlements 22459062 Accrued Pension & Other Long-Term Liabilities 99258317 121717379 X 456433621 -4687662 -4687662 461121283 797652 25278691 26076343 487197626 447713931 0 447713931 797652 443100 1240752 448954683 Part V, Line 4: The intended use of the endowment funds is to fund capital expenditures for medical equipment/provide healthcare prevention and services for the uninsured population in the service area. Part X, Line 2: The Hospital, CRHCDC, CRHVC, CH/DHC and the Trust are not-for-profit corporations as described in Section 501(c)(3) of the Internal Revenue Code, and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Management evaluated the System's tax positions and concluded the System has maintained its tax-exempt status, does not have any significant unrelated business income and had taken no uncertain tax positions that require adjustment to or disclosure in the accompanying consolidated financial statements. Part XI, Line 4b - Other Adjustments: Board Designated Spending 443,100. Pension Actuarial Loss 24,835,591. Part XII, Line 4b - Other Adjustments: Board Designated Spending 443,100. Central America and the Caribbean - Antigua & Barbuda, Aruba, Bahamas, 0 0 Investments - FMV as of 9/30/16 None 60206000 0 0 0 0 0 0 60206000 0 60206000 1 0 1 1 0 0 Part IV, Line 3: This organization did not have an ownership of any foreign corporation that would be greater than the 10% ownership filing threshold. Accordingly, IRS Form(s) 5471 is not required to be filed. Part IV, Line 4: The Organization meets the exception for tax-exempt organizations with respect to filing Form 8621. Form 8621 is not required to be filed for the Hospital. 1 1 1 X 225.000000000000 1 X 500.000000000000 1 1 1 0 1 1 6 5266 3806507 3806507 0.00880 52211906 25496758 26715148 0.06190 6 5266 56018413 25496758 30521655 0.07070 10 540809 2608547 699213 1909334 0.00440 6 7311 10246761 6497259 3749502 0.00870 24 390379 81906512 46281954 35624558 0.08260 1 23 93572 93572 0.00020 5 699949 699949 0.00160 46 938522 95555341 53478426 42076915 0.09750 52 943788 151573754 78975184 72598570 0.16820 45631 45631 0.00010 45631 45631 0.00010 1 6559542 951965 133387362 196663472 -63276110 X 1 1 1 1 Concord Hospital 250 Pleasant Street Concord NH 03301 01098 X X X X Concord Hospital 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X See Part V, Section C X X 1 15 1 See Part V, Section C 1 0 1 X 225.000000000000 500.000000000000 X X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X 1 X 0 X X X X 1 X 0 0 Concord Hospital Part V, Section B, Line 5: See the narrative for Schedule H, Part VI, line 2. Concord Hospital Part V, Section B, Line 7d: The Community Benefit Report was included in the Hospital's annual report and mailed to nearly 7,500 residents of the communities that the Hospital serves. It is also available on the State of New Hampshire's DOJ website and also the Concord Hospital website.The Hospital's Community Health Needs Assessment was on the Hospital's website with instructions on how to obtain a printed copy. Concord Hospital Part V, Section B, Line 11: See attached Implementation Plan to see how Concord Hospital is addressing the significant needs identified in its most recently conducted CHNA covered by this tax filing.Concord Hospital addressed all identified needs to a significant extent. The one need where the Organization had limited involvement was in the area of medical transportation, primarily because there are numerous services in the community that already address the need more effectively. Concord Hospital Part V, Section B, Line 16i: The Hospital includes information about charitable care services in many publications that go to the community. In addition, we collaborate with many community organizations that support the underserved and low income individuals and families; our financial assistance program is well understood by those agencies who often refer people to the program. Finally, our Financial Assistance staff reach out personally to the homeless through the monthly clinic at the homeless resource center to get them connected in as well as through the annual day of caring for the homeless. Schedule H, Part V, Section B, Line 7a & 10a: The CHNA is available at the Hospital facility's website: http://www.concordhospital.org/about/community-benefits/Implementation Strategy:http://www.concordhospital.org/app/files/public/811/CBP-Plan.pdf Schedule H, Part V, Section B, Line 16b: The Hospital's Financial Assistance Policy:http://www.concordhospital.org/patients-visitors/patient-financial-services/financial-assistance/The Hospital's Financial Assistance Policy Application:http://www.concordhospital.org/patients-visitors/patient-financial-services/financial-assistance/The Hospital's Plain Language Summary:http://www.concordhospital.org/patients-visitors/patient-financial-services/financial-assistance/financial-assistance-policy-plain-language-summary/ 56 1 - Concord Hospital Urgent Care 60 Commercial Street Concord NH 03301 Walk-in Urgent Care 2 - Capital Orthopaedic Srgry Ctr-Concord 264 Pleasant Street Concord NH 03301 Outpatient Surgery 3 - Concord Hospital Cardiac Associates 246 Pleasant Street Suite 103 Concord NH 03301 Outpatient Physician Services 4 - Concord Ambulatory Surgery Center 60 Commercial Street Suite 301 Concord NH 03301 Outpatient Surgery 5 - Concord Imaging Center 248 Pleasant Street Suite 106 Concord NH 03301 Imaging Services 6 - Center for Urologic Care 246 Pleasant Street Suite G2 Concord NH 03301 Outpatient Physician Services 7 - Concord Endoscopy Center 60 Commercial Street Concord NH 03301 Outpatient Endoscopy Services 8 - Concord Obstetrics and Gynecology 189 North Main Street Concord NH 03301 Outpatient Physician Services 9 - Concord Surgical Associates 246 Pleasant Street Suite 205 Concord NH 03301 Outpatient Physician Services 10 - Concord Hospital Family Health Center 250 Pleasant Street Concord NH 03301 Outpatient Physician Services 11 - Capital Orthopaedic Srgry Ctr-Concord 14 Tsienneto Road Suite 100 Derry NH 03836 Outpatient Surgery 12 - Concord Pulmonary Medicine 248 Pleasant Street Suite G100 Concord NH 03301 Outpatient Physician Services 13 - Center for Sports Med & Ortho Rehab 264 Pleasant Street Concord NH 03301 Rehabilitation Services 14 - Rehabilitation Services at Warner 2 East Main Street Warner NH 03278 Rehabilitation Services 15 - Concord Family Medicine 18 Foundry Street Suite 201 Concord NH 03301 Outpatient Physician Services 16 - Internal Medicine 248 Pleasant Street Suite 2800 Concord NH 03301 Outpatient Physician Services 17 - Concord Imaging Center 60 Commercial Street Suite 101 Concord NH 03301 Imaging Services 18 - Concord Plastic Surgery 246 Pleasant Street Suite 210 Concord NH 03301 Outpatient Physician Services 19 - Concord Hospital Sleep Center 18 Foundry Street Suite 103 Concord NH 03301 Outpatient Sleep Services 20 - Concord Hospital Cardiac Ass-Laconia 85 Spring Street Suite 2A1 Laconia NH 03246 Outpatient Physician Services 21 - Neurology Associates 248 Pleasant Street Suite G200 Concord NH 03301 Outpatient Physician Services 22 - Pleasant Street Family Medicine 280 Pleasant Street Concord NH 03301 Outpatient Physician Services 23 - Family Tree Healthcare Hopkinton 19 Farrington Corner Road Hopkinton NH 03229 Outpatient Physician Services 24 - Penacook Family Physicians 4 Cresent Street Peacock NH 03303 Outpatient Physician Services 25 - Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Physician Services 26 - Epsom Family Medicine 1990 Dover Road Epsom NH 03234 Outpatient Physician Services 27 - CardiacThoracic Surgery 246 Pleasant Street Concord NH 03301 Outpatient Physician Services 28 - Rehab Services CH Med Office-North 18 Foundry Street Suite 101 Concord NH 03301 Rehabilitation Services 29 - Rehab Serv CH Med Off-Horseshoe Pnd 60 Commercial Street Suite 403 Concord NH 03301 Rehabilitation Services 30 - Family Care Of Concord 248 Pleasant Street Suite 2600 Concord NH 03301 Outpatient Physician Services 31 - Concord Hosp Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Outpatient Physician Services 32 - Family Tree Healthcare Warner 2 East Main Street Warner NH 03278 Outpatient Physician Services 33 - Reha Services CH Medical Office-East 1990 Dover Road Suite 201 Epsom NH 03234 Rehabilitation Services 34 - Rehabilitation Services at Pembroke 121 Pembroke Street Pembroke NH 03275 Rehabilitation Services 35 - Internal Medicine at Horseshoe Pond 60 Commercial Street Suite 401 Concord NH 03301 Outpatient Physician Services 36 - International Travel Clinic 246 Pleasant Street Suite 104 Concord NH 03301 Outpatient Physician Services 37 - Concord Imaging Center 1990 Dover Road Epsom NH 03234 Imaging Services 38 - Family Tree Healthcare Concord 81 Hall Street Concord NH 03301 Outpatient Physician Services 39 - Lab-Memorial Medical Office Building 246 Pleasant Street Concord NH 03301 Outpatient Laboratory Services 40 - Capital Region Palliative Care & Hospice 246 Pleasant Street Suite 206 Concord NH 03301 Outpatient Physician Services 41 - Concord Hosp Fam Hlth Ctr Behav Hlth 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Counseling Services 42 - Concord Hosp Fam Hlth Ctr Behav Dental 250 Pleasant Street Yeaple Building Concord NH 03301 Dental Services 43 - Anti-Coagulation Clinic Internal Med 248 Pleasant Street Suite 2800 Concord NH 03301 Outpatient Physician Services 44 - Anti-Coag Clinic Concord Fam Med 18 Foundry Street Suite 201 Concord NH 03301 Outpatient Physician Services 45 - Center for Health Promotion 49 South Main Street Concord NH 03301 Health Promotion Services 46 - Lab CH Medical Off at Horseshoe Pond 60 Commercial Street Concord NH 03301 Outpatient Laboratory Services 47 - Lab CH Medical Offices-East 1990 Dover Road Epsom NH 03234 Outpatient Laboratory Services 48 - Concord Family Medicine Havenwood 149 East Side Drive Concord NH 03301 Outpatient Physician Services 49 - Family Health Center Lab 250 Pleasant Street Yeaple Building Concord NH 03301 Outpatient Laboratory Services 50 - Radiology Srv Fam Hlth Ctr-Hillsboro 15 Antrim Road Hillsboro NH 03244 Radiology Services 51 - Rehab ServicesFam Health Ctr-Hilloro 15 Antrim Road Hillsboro NH 03244 Rehabilitation Services 52 - Breast Care Center 248 Pleasant Street Suite 206 Concord NH 03301 Imaging and Counseling service 53 - Lab Penacook Family Physicians 4 Cresent Street Penacook NH 03303 Outpatient Laboratory Services 54 - Lab Heights 149 East Side Drive Concord NH 03301 Outpatient Laboratory Services 55 - Lab Family Tree Warner 2 East Main Street Warner NH 03278 Outpatient Laboratory Services 56 - Lab Family Physicians of Pembroke 121 Pembroke Street Pembroke NH 03275 Outpatient Laboratory Services Part I, Line 7: Subsidized Health Services represents those activities that assure access to medical care and support for people with special medical needs and who may be faced with chronic health conditions, many of these activities also ensure access to needed health services which might otherwise not be available without subsidized or special support. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 17,588,543. Part II, Community Building Activities: In fiscal year 2016, Concord Hospital continued its emergency preparedness initiatives by hosting a multi-agency emergency preparedness exercise with the measurement of program success being outside agency responders able to properly respond within the response parameters and the risk of damage, injury or fatality is mitigated to the best level possible. Part III, Line 2: The amount reported on Part III, Line 2 was derived by applying the cost to charge ratio against the amount of bad debt expense reported on Form 990, Part IX, Line 25, Column (A). Accounts Receivable: The allowance for doubtful accounts is provided based on an analysis by management of the collectability of outstanding balances. Management considers the age of outstanding balances and past collection efforts in determining the allowance for doubtful accounts. Accounts are charged against the allowance for doubtful accounts when deemed uncollectible. Charity Care: The System provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the System does not pursue collection of amounts determined to qualify as charity care, they are not reported as community benefit. The amount on Line 3 is calculated by determining the revenue for all patients that have completed an application for financial assistance and only reporting the amount for those that did not complete the financial assistance process for any number of reasons and were then transferred to bad debt. Part III, Line 3: See narrative for Part III, Line 2. Part III, Line 4: See page 10 of the attached audited financial statements. Part III, Line 8: The Medicare shortfall of $63,276,110 is funded through cost shifting to other payors. In addition, many of the subsidized health services reported on line 7g include some revenue and expenses from services to Medicare patients, Medicare allowable costs on line 5 were determined using the Hospital's filed Medicare cost report, which determines cost via the cost to charge ratio methodology.In accorance with the regulations, the Hospital has not included its $63,276,110 Medicare shortfall as a community benefit in Part I. However, we believe that this shortfall provides a tremendous benefit to the community in that it enables the Hospital to provide essential services to a vast number of patients who otherwise would not have access to the Hospital's care. Part III, Line 9b: The Hospital has a Financial Assistance policy in addition to, and complementing, the bad debt collection policy. The policy describes the Hospital's program of financial assistance for medically necessary services to individuals and families who are uninsured, underinsured, or who experience a catastrophic healthcare event and do not quality for any other state or federal assistance programs. Patient education of eligibility for assistance is described below in the statement for Part VI, Line 3. Part VI, Line 2: Every three years, the Hospital facilitates a comprehensive community health needs assessments, engaging numerous community organizations and health partners in the process, to identify far-reaching health needs faced by people in the communities served by the Hospital. Assessment methodologies address both quantitative and qualitative data and include stakeholder interviews, focus groups, community listening sessions, web survey, written surveys, telephone surveys and analysis of various data sets. Assessment results are shared with the communities and serve as the basis to develop new or expanded services in response to need. The most recent assessment covered by this tax return was completed in the tax year of 2015. Part VI, Line 3: The Hospital actively meets with all people who indicate that they do not have insurance or will have difficulty paying their obligations, to inform and work with them to understand what local programs are available to them, including how they can benefit from the Hospital's Financial Assistance program. Part VI, Line 4: Concord defines its Primary Service Area as 28 communities to which it has close geographic proximity and significant market share. According to the State of New Hampshire's "Concord Healthcare Service Area Regional Health Profile, 2001," the 28 communities that comprise the Hospital's PSA represent, in terms of square miles, the largest hospital service area in the State. Together, these communities cover an area of nearly 900 square miles. The Hospital serves all the residents of these towns as well as many others from across the State of New Hampshire through its regional and statewide referral for specialty care, including orthopedic, cardiology, oncology, and urological care. Part VI, Line 5: Part I line 6A, Concord Hospital develops programs and services to address community health needs and makes investments in initiatives that align with the Hospital's core mission. A reasonable amount of Concord Hospital's community benefit investment remains in the area of charitable care to ensure that those without insurance or with limited insurance have access to needed medical care. The Hospital strives to address the needs of vulnerable populations including our low-income neighbors and other vulnerable populations. The Hospital's Family Health Centers ensure access to primary, behavioral health, and dental care for our region's most vulnerable residents, which address identified community health needs. Those achievements are at the heart of our community benefit activity. Beyond that focus are programs and services that benefit every resident and support that far reaching goal of a healthier community. The Hospital continued its efforts toward promoting the health of the community by investing its surplus funds in new inpatient facilities to enhance patient care, by providing funding support to Capital Region Healthcare affiliates through the community services fund for programs that address identified community needs and serve vulnerable populations, and by continuing to recruit new primary care physicians to enhance access in the community.Finally, per the Instructions to Schedule H, Part I, the Hospital has not included its $63,276,110 Medicare shortfall as-a community benefit in Part I. However, we believe that this shortfall provides a tremendous benefit to the community in that it enables the Hospital to provide essential services to a vast number of patients who otherwise would not have access to the Hospital's care. Part VI, Line 7, Reports Filed With States NH 1 Riverbend Community Mental Health PO Box 2032 Concord NH 03301 020264383 501(c)(3) 293077 Support to provide funding for: psychiatric care manager and psychiatric APRN, co-located care services at Concord Hospital Medical Group practices, and funds for discounts and scholarships to be awarded by RCMH for individuals in the Intensive Outpatient Therapy and Medication Assisted Therapy programs. 1 Part I, Line 2: The Hospital works with the Concord Hospital Trust to administer grants provided from funds available through the Community Services Funds. The Trust has an open application process for those entities that meet the grant requirements, and the Trust Board approves and recommends to the Hospital Board, all recommended granting actions. The Trust provides annual monitoring of compliance with expected spending requirements and gets updates as needed. X X X X X 0 1 0 0 0 0 0 1 0 D Thomas Akey MD Trustee (thru 1/16) 283334 0 12250 0 3597 0 48050 0 20346 0 367577 0 0 0 Diane E Wood Allen RN Trustee (thru 7/16) 224840 0 31717 0 1450 0 48520 0 13827 0 320354 0 0 0 David A Stevenson MD Trustee 232802 0 23114 0 524 0 22206 0 19794 0 298440 0 0 0 Robert P Steigmeyer President & CEO 573294 0 231250 0 828 0 133000 0 18032 0 956404 0 0 0 Bruce R Burns Treasurer 384782 0 88903 0 2376 0 48050 0 13932 0 538043 0 0 0 David Green MD Chief Medical Officer 389324 0 103151 0 2617 0 48050 0 17344 0 560486 0 0 0 Gerald Sardella MD Physician 559733 0 16790 0 1242 0 20254 0 21817 0 619836 0 0 0 Joe Conley COO 326778 0 93647 0 2191 0 48543 0 17923 0 489082 0 0 0 George Pope MD Physician 452725 0 17121 0 464 0 20150 0 21760 0 512220 0 0 0 Todd Burdette MD Physician 374131 0 75665 0 579 0 36649 0 21372 0 508396 0 0 0 Part I, Line 4b Robert P. Steigmeyer, President & CEO, participated in a 457(f) plan with Concord Hospital during the fiscal year. After a three-year vesting period which began in 2014, there will be a 457(f) amount included in taxable W-2 wages for Mr. Steigmeyer reported on Schedule J, Part II, Column B(iii). This future amount will be comprised of earnings and deferred compensation that is included in Schedule J, Part II, Column C. On October 29, 2014 $78,750 was approved to be credited into Mr. Steigmeyer's 457(f) plan account for fiscal year ended September 30, 2014. There were contributions to Mr. Steigmeyer's 457(f) plan for fiscal years ended September 30, 2015 and 2016 of $115,000 and $120,000, respectively. Part I, Line 7 Incentive Pay: The primary purpose of the incentive pay is to recognize the quality of the performance of the CEO, CFO, and CMO during the preceding fiscal year. The amount of the incentive pay bonus is based on performance relative to strategic goals and measurable objectives. When the executive's performance excels, the incentive pay should reflect the accomplishment and allow for the sum of base salary and incentive pay to reach as high as the 75th percentile of peer institutions. A NH Health & Education Facilities Authority 020279866 644614K65 2011-03-01 50095322 Facility Improvements/Renovations 0 0 0 B NH Health & Education Facilities Authority 020279866 644614Z85 2013-02-01 48631000 Facility Improvement Project & Advance Refund Series 2001 NHHEFA Bonds 0 0 0 C NH Health & Education Facilities Authority 020279866 2013-04-01 32421000 Advance Refund the Series 2004 NHHEFA Hospital Revenue Bonds 0 0 0 A 50095322 544891 2012 1 0 1 1 B 48631000 561439 2014 1 0 1 1 C 31800000 32421264 64503 2013 0 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 0 0 1 0 0 1 Naxis Funding Corp 1.800000000000 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 Date Rebate Computation Performed Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 03/17/2016 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 01/31/2016 Issuer Name: NH Health & Education Facilities Authority Date the Rebate Computation was Performed: 06/30/2016 Form 990, Part VI, Section A, line 4 The Hospital revised its bylaws for the following significant changes: A. The compensation of the Hospital's President, which was previously determined by the Board, is now subject to the following procedures: The compensation for the President shall be authorized and approved by the Compensation Committee in a manner that qualifies for the rebuttable presumption of reasonableness available under the Intermediate Sanctions regulations, but, to the extent such compensation may constitute a pecuniary benefit transaction (as defined by RSA 7:19-a and as referenced in Article 9), no such compensation shall be payable until also approved by the Board in a manner that satisfies RSA 7:19-a. B. The provisions in the bylaws outlining the duties of the Compensation Committee were revised to read as follows: 1.To annually review the performance of the President. 2.To annually review and approve the compensation (including changes in compensation) of the President (and other members of senior management as the Compensation Committee deems appropriate) in a manner that qualifies for the rebuttable presumption of reasonableness under the Intermediate Sanction regulations, provided that to the extent such compensation may constitute a pecuniary benefit transaction (as defined by RSA 7:19-a), no such compensation shall be payable until also approved by the Board in a manner that satisfies RSA 7:19-a. The Compensation Committee may, as necessary, select and establish compensation for a consultant to assist in this process. 3.To provide to the Board a full and fair disclosure of the material facts of any compensation arrangement that may constitute a pecuniary benefit transaction (as defined by RSA 7:19-a). 4.Review and reassess the adequacy of the committee charter and executive total compensation philosophy annually, and recommend amendments to the Board for approval as the Compensation Committee deems appropriate. The committee charter and executive total compensation philosophy (and any amendments thereto) shall become effective when approved by the Board in accordance with these Bylaws. Form 990, Part VI, Section A, line 6 Capital Region Health Care Corporation, a charitable corporation, acting through its board of trustees, is the sole Member of the Hospital. Form 990, Part VI, Section A, line 7a The Board of Trustees shall be composed of not less than fourteen nor more than nineteen persons excluding ex-officio Trustees, the number to be established and elected by the Member. Form 990, Part VI, Section A, line 7b The affairs of the Hospital shall be managed by the Trustees who shall have and may exercise all the powers of the Hospital except those reserved to the Member by law, the Articles of Agreement, or the Bylaws. In addition: -Any voluntary dissolution, merger or consolidation of the Hospital or the sale or transfer of all or substantially all of the Hospital's assets or the creation or acquisition of any subsidiary or affiliate corporation shall be subject to approval by the Member. -Any amendment of the Hospital's Bylaws or Articles of Agreement shall be subject to approval by the Member. -Any changes in the Hospital's non-profit status shall be subject to approval by the Member. Form 990, Part VI, Section B, line 11 The 990 is reviewed in detail with the Audit Committee of the Board of Trustees. All board members receive a copy of the 990 to review prior to filing the report. Form 990, Part VI, Section B, line 12c Each Trustee, officer and committee member, upon entering the duties of his/her office and annually thereafter, will be advised of this policy and shall sign a statement acknowledging his/her understanding of and agreement to this policy. Annual reviews will adhere to state regulations that require public notice for any significant pecuniary transaction. Form 990, Part VI, Section B, line 15 The evaluation of the performance of the Chief Executive Officer ("CEO") of Concord Hospital and its subsidiaries (collectively the "Hospital") is an important responsibility of the Board of Trustees (the "Board") and is vital in ensuring that the Hospital meets its mission. The Board has delegated the responsibility of initiating the process of conducting the CEO's performance evaluation and initiating the process of setting the CEO's compensation to the Board's Compensation Committee. The Compensation Committee also is charged with the responsibility of reviewing the appropriateness of the compensation of the Hospital's Chief Operating Officer, Chief Financial Officer, and Chief Medical Officer as proposed by the CEO. The Compensation Committee shall present its report of the CEO's annual performance to the Board for its further input and consideration. The Compensation Committee shall also make its recommendation to the Board concerning the CEO's compensation. Finally, the Compensation Committee shall make its recommendation to the Board concerning the compensation of the COO, CFO, and CMO. The Board shall review the recommendations of the Compensation Committee as to the compensation of the Hospital's CEO, COO, CFO, and CMO and shall set their compensation as the Board deems appropriate. Although the Hospital continues to value the role of Capital Region Health Care Corporation ("CRHC") and the Hospital's participation in that organization, the Board acknowledges that it is not the responsibility of the Board to evaluate or set the compensation of the Chief Executive Officer of CRHC. Neither is it the role of the Board of Trustees of CRHC to evaluate, or set the compensation of, the Hospital's CEO. Accordingly, CRHC's Board of Trustees is not involved in evaluating or setting the compensation of the Hospital's CEO. The Board acknowledges that the Hospital's CEO may also serve as the Chief Executive Officer of CRHC and that the Hospital may charge CRHC for these services. The Board may consider the comments of the Board of Trustees of CRHC, as outlined herein, when deemed relevant in evaluating the performance of the Hospital's CEO. The Board directs that the Compensation Committee and the Board itself, in their respective undertakings of recommending and setting the compensation of the Hospital's CEO, COO, CFO, and CMO, avoid conflicts of interest and be guided by the "rebuttable presumption of reasonableness" regulations under the so-called "Excess Benefit Transaction" provisions of the Internal Revenue Code ("IRC"). The Board authorizes the Compensation Committee to use such financial and advisory (e.g., legal counsel, consultant) resources as it reasonably deems appropriate to fulfill its duties in evaluating the CEO's performance and in making its recommendations to the Board regarding compensation for the CEO, COO, CFO, and CMO. Form 990, Part VI, Section C, line 19 Yes, the organization makes all of this information available to the public. Audited financial statements and the most recent quarter ended financial statements are posted on the Hospital's web site, www.concordhospital.org. In addition to this, the Hospital sends its annual report, including a financial summary, to members of the community via the US Postal service. Governing documents and conflicts of interest filings adhere to state regulations that require public notice for any significant pecuniary transaction. Form 990, Part XI, line 9: Pension Actuarial Loss -24,835,591. Equity Transfer from Affiliate 6,779,959. Form 990, Part XII, Line 2c There was no change in the process for oversight of the audit and compilation of financial statements for the fiscal year. The Board has a finance committee, which reviews the financial statements monthly. There is also an audit committee of the Board, which reviews the annual audit process and the selection of the independent accountant. The same independent firm of accountants performed the audit for the fiscal years ending 9/30/15 and 9/30/16. Form 990, Part VII: Dr. Thomas Akey, Diane E. Wood Allen, RN, and Dr. David A. Stevenson are all listed in Form 990, Part VII as voting members of the Hospital's governing body. Each was also employed by the Hospital as full-time physicians or other medical personnel and received compensation and benefits related to their services to the Hospital in their capacity as employees. None of the above listed individuals' compensation and benefits reflect remuneration in their capacity as board members of the Hospital. In accordance with IRS instructions, they have not been listed as independent board members in Form 990, Part VI, Line 1b. Form 990, Part IX, Column D: Although the Hospital is reporting contribution income on Form 990, Part VIII, Line 1 it is not reporting any fundraising expenses on Form 990, Part IX, Line 25, Column D. All philanthropic activity is conducted by the Hospital's affiliate, Concord Hospital Trust. All contribution revenue is first received by the Trust which is then granted to the Hospital. All fundraising expenses related to this solicitation of contribution revenue is reported on Concord Hospital Trust's Form 990, Part IX, Column D. Capital Region Health Care Corporation 250 Pleasant Street Concord NH 03301 020222123 Promote comprehensive health service system NH 501(c)(3) Line 11a, I N/A 0 Capital Region Health Physicians Group 250 Pleasant Street Concord NH 03301 020481705 Inactive NH 501(c)(3) Line 9 Concord Hospital 1 Capital Region Health Ventures Corp 250 Pleasant Street Concord NH 03301 020438264 Provide medical care to community NH 501(c)(3) Line 11b, II Concord Hospital 1 Capital Region Health Care Development Corporation 250 Pleasant Street Concord NH 03301 020429749 Support Concord Hospital & other affiliates NH 501(c)(2) Concord Hospital 1 Concord Regional Visiting Nurse Association Inc PO Box 1797 Concord NH 033021797 020222122 Home health care & hospice services NH 501(c)(3) Line 9 Capital Region Health Care Corp 0 Riverbend Community Mental Health Inc 3-5 North State Street Concord NH 033022032 020264383 Multi-service team NH 501(c)(3) Line 7 N/A 0 CHDHC Inc 250 Pleasant Street Concord NH 03301 020519680 Provide health services to Concord community NH 501(c)(3) Line 9 Concord Hospital 1 Concord Hospital Trust 250 Pleasant Street Concord NH 03301 260378710 Fundraising NH 501(c)(3) Line 11a, I Concord Hospital 1 Concord Imaging Center LLC 2 1/2 Beacon Street Concord NH 03301 020436605 Provide radiology services to community NH N/A Capital Orthopedic Surgery Center 250 Pleasant Street Concord NH 03301 020522860 Provide medical care to community NH N/A Concord Ambulatory Surgery Center LLC 60 Commerical Street Concord NH 03301 201184704 Provide medical care to community NH N/A Concord Endoscopy Center LLC 60 Commerical Street Concord NH 03301 201184756 Provide medical care to community NH N/A Capital Region Health Services Corporation 250 Pleasant Street Concord NH 03301 020428631 Medical services NH N/A C 0 Capital Region Primary Care Corporation 250 Pleasant Street Concord NH 03301 020495275 Inactive NH Concord Hospital C 1.00000 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 Capital Region Health Care Development Corp A 1441707 Actual per books Capital Region Health Care Corp J 100530 Actual per books Capital Region Health Care Corp B 236364 Actual per books CHDHC B 3563 Actual per books Capital Region Health Care Ventures Corp C 6586460 Actual per books Capital Region Health Care Services Corp C 319302 Actual per books Capital Region Health Care Development Corp K 2982318 Actual per books Capital Region Health Care Development Corp O 552791 Actual per books Capital Region Health Care Ventures Corp O 474245 Actual per books Concord Hospital Trust O 738291 Actual per books Capital Region Health Care Development Corp P 35227 Actual per books Capital Region Health Care Ventures Corp Q 336853 Actual per books CHDHC P 3563 Actual per books Concord Hospital Trust Q 244486 Actual per books Schedule R, Part III: In accordance with IRS instructions, the partnerships listed in Part III are being reported due to their control relationship with Capital Region Health Ventures Corp and the Hospital's control relationship with Capital Region Health Ventures Corp. During the year, the hospital system invested in Granite Healthcare Asset Holding Company, LLC, a joint venture with several hospital facilities. The Hospital's investment in this entity does not otherwise meet the disclosure requirements for Schedule R, Part III.